窄带光成像放大内镜下B2型血管预判表浅食管鳞状细胞癌浸润深度的准确率及影响因素分析
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1.福建医科大学省立临床医学院 350001;2.福建省立医院消化内镜中心 350001

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国家自然科学基金(61675043)


Accuracy and influencing factors of type B2 vessels for predicting the invasion depth of superficial esophageal squamous cell carcinoma under narrow band imaging‑magnifying endoscopy
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Fujian Provincial Hospital

Fund Project:

National Natural Science Foundation of China (61675043)

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    摘要:

    目的 评估窄带光成像放大内镜(narrow band imaging‑magnifying endoscopy,NBI‑ME)下B2型血管预测表浅食管鳞状细胞癌浸润深度的准确率,并探索预测过度及不足的影响因素。方法 2015年1月—2020年4月在福建省立医院内镜中心完成NBI‑ME评估食管肿瘤浸润深度,NBI‑ME下发现B2型血管,并经术后病理证实为表浅食管鳞状细胞癌的86例病例合计86处癌灶纳入病例对照研究。按术后病理结果分成预测正确组(n=25)和预测错误组(n=61),计算预测的准确率。进一步将预测错误组分成预测过度组(n=49)和预测不足组(n=12),分别与预测正确组进行对比分析,以分别发现预测过度和预测不足的影响因素,再进一步行多因素Logistic回归分析,探寻各自的独立危险因素。结果 ME‑NBI下B2型血管预测表浅食管鳞状细胞癌浸润深度的准确率仅为29.07%(25/86),其中预测过度率和不足率分别为56.98%(49/86)和13.95%(12/86)。单因素分析发现:B2区域分类构成(χ2=36.25,P<0.001)、有无内镜下显著特征(即结节、增厚、明显凹陷,χ2=22.90,P<0.001)、B2血管周围是否伴有炎症侵蚀(χ2=9.54,P=0.004)与B2型血管过度预测表浅食管鳞状细胞癌浸润深度有关,内镜下有无显著特征与B2型血管预测表浅食管鳞状细胞癌浸润深度不足有关(P=0.016)。多因素Logistic回归分析结果显示:小区域B2(P<0.001,OR=241.988,95%CI:15.229~3 845.252)和B2血管周围伴有炎症侵蚀(P=0.033,OR=12.801,95%CI:1.226~133.713)均是B2型血管过度预测表浅食管鳞状细胞癌浸润深度的独立危险因素,而内镜下有显著特征是B2型血管过度预测表浅食管鳞状细胞癌浸润深度的独立保护因素(P<0.001,OR=0.012,95%CI:0.001~0.150);内镜下有显著特征是B2型血管预测预测表浅食管鳞状细胞癌浸润深度不足的独立危险因素(P=0.027,OR=7.899,95%CI:1.259~49.565)。结论 仅依据NBI‑ME下B2型血管预测表浅食管鳞状细胞癌浸润深度的准确率较低,较易发生预测过度的情况。虽然小区域B2、B2血管周围伴有炎症侵蚀和内镜下无结节、增厚、明显凹陷与NBI‑ME下B2型血管过度预测表浅食管鳞状细胞癌浸润深度密切相关,且内镜下有结节、增厚、明显凹陷还与B2型血管预测表浅食管鳞状细胞癌浸润深度不足密切相关,但NBI‑ME下B2型血管联合评估B2型区域大小及内镜下表现能否提高对表浅食管鳞状细胞癌浸润深度的预测准确率还需要后续研究证实。

    Abstract:

    Objective To evaluate type B2 vessels for predicting the invasion depth of superficial esophageal squamous cell carcinoma (SESCC) under narrow band imaging‑magnifying endoscopy (NBI‑ME), and to analyse the influencing factors of over‑prediction and under‑prediction. Methods A total of 86 SESCC patients with 86 lesions confirmed by postoperative pathology, who underwent NBI‑ME to evaluate the invasion depth of esophageal tumor and were observed for type B2 vessels in Department of Digestive Endoscopy of Fujian Provincial Hospital from January 2015 to April 2020, were included in the case‑control study. According to the postoperative pathological results, the patients were divided into the correct prediction group (n=25) and the wrong prediction group (n=61), and the accuracy of prediction was calculated. The wrong prediction group was further divided into the over‑prediction group (n=49) and the under‑prediction group (n=12) to find the influencing factors of over‑prediction and under‑prediction, respectively. Further, multivariate Logistic analysis was performed to explore the independent influential factors for the prediction. Results The accuracy of type B2 vessels under NBI‑ME for predicting the invasion depth of SESCC was only 29.07% (25/86), and the over‑prediction rate and under‑prediction rates were 56.98% (49/86) and 13.95% (12/86), respectively. Univariate analysis showed that the classification of type B2 area (χ2=36.25, P<0.001), the distinct endoscopic features (nodules, thickening and obvious depression, χ2=22.90, P<0.001), and inflammation around type B2 vessels (χ2=9.54, P=0.004) were related to the over‑prediction of the invasion depth of SESCC, and the distinct endoscopic features were related to the under‑prediction of the invasion depth (P=0.016). Multivariate Logistic regression analysis showed that B2-narrow (type B2 area ≤5 mm) (P<0.001, OR=241.988,95%CI:15.229-3 845.252) and inflammation around type B2 vessels (P=0.033, OR=12.801, 95%CI: 1.226-133.713) were independent risk factors for over‑predicting the invasion depth of SESCC, while the distinct endoscopic features were independent protective factors for over‑prediction (P<0.001, OR=0.012, 95%CI: 0.001-0.150). The distinct endoscopic feature was an independent risk factor for under‑predicting invasion depth of SESCC with type B2 vessels (P=0.027, OR=7.899, 95%CI: 1.259-49.565). Conclusion The accuracy of predicting the invasion depth of SESCC is low only based on type B2 vessels in NBI‑ME, and over‑prediction is prone to occur. B2-narrow, inflammation around type B2 vessels and without nodules, thickening and obvious depression are closely related to the over‑prediction of invasion depth of SESCC by type B2 in NBI‑ME, and nodules, thickening and obvious depression are closely associated with the under‑prediction. However, whether the combined assessment of type B2 vessels under NBI‑ME and endoscopic manifestation can improve the accuracy of prediction needs to be confirmed by further studies.

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林旭,邓万银,梁玮.窄带光成像放大内镜下B2型血管预判表浅食管鳞状细胞癌浸润深度的准确率及影响因素分析[J].中华消化内镜杂志,2022,39(2):108-113.

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  • 收稿日期:2020-10-18
  • 最后修改日期:2021-12-26
  • 录用日期:2021-01-19
  • 在线发布日期: 2021-12-28
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